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iYPE OR PRINT ONLY <br />Owner <br />ApPlicant <br />. Appliwtion For <br />PUBLIC �..ORKS PERMIT <br />PUBLIC WORKS DEPARTMENT <br />3200 Cedar Sireet <br />Everett, WA 98201 259-BB1n <br />Describe Proposed Wark _ <br />Plan Check No: B 51815 SEPA <br />Applical.Date: OS/23�96 <br />Job Addreee: 65b1 EVERLY BLVD <br />Owner: FREES J11MES/KAREN <br />Tenant: <br />Propoaed Uee: GARAGE <br />Desc. of Work: <br />NEW DETACNED GARAGE <br />OFFICE SET JOB SET <br />APPROVED FOR PERMIT: DATE_/_/_ BY <br />PROJECTADDRESS ((f known) <br />D� <br />Publle Works Permlt A <br />BuIlding Permit N _ <br />Public Nbrks Fee 5 <br />Pnone <br />Phone <br />Attach �: �r (4) coples of plans lor propcsed work - Draw to scale and note the folfowir,g if applicable: <br />•Property Lln� 'Outlina ard dimxnsions ol all existing and proposed structures on the lot •6clsting and proposed utillties <br />'Centerllne of sireet •Indiwte North •Show any proposed grading changes •Shaw measureR,�nts <br />PERMIT CONDITIONS: <br />1. All calls for inspection shall i,e made 24 hours in advance - phone 259-8810. <br />2. All work shall be pertormed in accordance with th(s permit and current City of Everett Design and <br />C�nstructlon Standards and Specificatlons. <br />3. Call Lccation Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. <br />��� /-���/,z ��r/aY/1 /��,�,���� <br />������- <br />. �/�/� <br />Approved for Coostructlon Date <br />FINAL �NSPECTION Date <br />Approved as Consiructed <br />♦�� <br />V♦ <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDI110t�[� <br />The undersigned owner/epplicant hereby agrees to holtl and save hartnless <br />tho City of Everett from eny and all claims for damaaes, cocts, expenses, or <br />causes of action that may arisa because of Installatlon end maintenance of <br />the Improvement or other rlght-ol-way use heralo applied for �ind further agrees <br />m remove same upon notice from �he Ctty and to �eplacN public pmperty <br />damaged there6y. <br />SiynaWre ol Applicant Date <br />WORK AUTHORIZED BY THIS PERMIT MUST dE STARTED WITHIN !BO DAYS OF DATG PERMIT IS ISSUED AND THEREAFfER IS TO BE DIUGENTLY I�I IRSUED TO <br />COMPLE710N.'fH15 PERMIT MAY BE CANCELLED BY THE CI1Y UPO� ANY STOPPAi3E OF WORK ON THIS PROJECT OVER 90 DAYS DURATION. <br />